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EF: 2020 was the year of diagnostics, 2021 the year of vaccines; what do you think 2022 will bring? 

HG: I hope we will achieve normality. I have been reading reports regarding Covid, and as a physician, I am sure it will become an endemic disease. Coronavirus has existed for over a hundred years as one of the viruses that cause flu, but the Covid-19 strain was very aggressive and pathogenic. Now that Covid seems to be endemic, we can hopefully achieve a semblance of normality, although it maybe won't be the pre-pandemic normal. Since, we have learned to develop, apply and use new digital ways of serving patients in a new healthcare delivery system.  

EF: Could you elaborate on Christus Muguerza's role in Mexico during the pandemic? 

HG: We were better prepared to cope with the pandemic than the United States-based healthcare systems because we started following Covid behaviour and pandemic as far back as 2019. We knew that sooner or later, Covid would strike in Mexico, and we prepared for it. Three to six weeks before we got the first patient, we were ready; we had a lot of PPE, and the hospitals were segregated following epidemiological recommendations of the CDC. We never ran out of PPE, and our employees never got infected within the clinical setting. Over the last two years, a few got infected using the public transport system or other places, but not in the clinical setting.

We were the first private healthcare system in Mexico to provide a Chatbot in the market to help people evaluate if they were at risk of getting Covid. We called our Chatbot Covi-Med -still in place on the internet- and once the Chatbot identified a high-risk person, it connected that person to a specialized physician on our 24/7 platform and for free. The physician could connect the patients to a hospital or recommend continuing their care at home. We reached 27 or 28 million people through Chatbot consultations. We worked with the Asociación de Hospitales Privados (the Mexican Association of Private Hospitals). With the association's former president, we developed "Todos Juntos contra el Covid" (All Together against Covid), allocating up to 50% of private beds to public state hospitals to combat Covid-19. We were also part of the specialized Health Safety Committee in the United States, and we continued to serve non-Covid patients during the pandemic.  

EF: There has been a massive emphasis on communicable diseases these last two years; how can the importance of chronic diseases be restored and bring patients back to care and regular checks? 

HG: During the worst of the pandemic, patients were scared to come to hospitals, and as a result, we now have many non-Covid patients with complications due to delayed attention. The use of technology has been a cornerstone in getting the patients back to care. We organized webinars and educational programs for the community during the pandemic to help them feel safe about going to the hospital when essential. Through technology, we provided digital platforms to our customers -employers, insurance companies, and the community. We convey educational tips and provide tools for patients to schedule consultations virtually, so they only come to the hospital for a specific consultation. We will continue to drive all digital initiatives. We are launching a telemedicine platform which has been a slower process because the culture in Mexico prefers face-to-face communication with the physician. We advance step by step, and we are slowly but surely making progress in telemedicine and electronic medical records. This system will be remarkable, particularly for high-risk patients with hypertension or diabetes, as they can avoid going to the hospitals. Telemedicine will be the solution not to expose high-risk patients. Ninety per cent of our doctors are private practitioners, so they also needed the tools to connect with patients, and during the pandemic, we gave all these platforms and tools for free. We are now including the platforms in our portfolio to provide a more integrated continuum of care. 

EF: What can be done in Mexico to reduce out-of-pocket expenditure?  

HG: The out-of-pocket health expenditure in Mexico is high because people think public health is insufficient, and they spend more and more on health from their pockets. Attention, resources, and more focus must be aimed at encouraging people to go to primary care centres because at least 70% of the out-of-pocket expenditure is spent on primary care. It is critical to provide good primary care as they do in Spain, where health is mainly state-based and offers excellent services.  

EF: Could you elaborate on the shared benefit networks (Beneficio de la Red Compartida) and how they can help change the healthcare industry in Mexico?  

HG: Our healthcare system is fragmented, all the players are on the same line, and the patients go directly to the specialists skipping the primary care physician. Each player performs individually, and we are proposing an integrated network that is not linear but more like a mesh, sharing purpose, goals, and benefits. When the continuum of care is linear, each player searches for individual financial benefits, making health very expensive. We must keep the cost of the services within certain boundaries and share the benefits, understanding that no one of us can take all the profits. Nor is it good for the patient to go skipping from one player to another, with each part pursuing financial benefit. Healthcare must work as a unit instead of multiple components and become a cost-transferring system -a better way to provide healthcare.  

EF: What is the importance of the role of healthcare in the Mexican health economy?  

HG: In most countries, at least three central issues must be addressed and solved: Health, Education, and Safety. Healthcare comes first because we can't achieve the other two without health. Health management in a country is crucial; in Mexico, 16% of the total population is diabetic, which means about 24 million people have diabetes. We must seriously address society's healthcare first; if we don't focus on healthcare, it will be impossible to allocate the right resources to safety, education, infrastructure, or anything else. As a country, we need to work vehemently on building healthier communities and healthier people.  

EF: What would be your advice to a business leader interested in investing in healthcare in Mexico? 

HG: There are many opportunities to invest in healthcare, but any potential investor must understand that the correct model is sharing benefits. All the players must be connected, sharing objectives, goals, responsibilities, and benefits.  

EF: When hiring talent, what are the new skill sets to look for in employees?   

HG: The skillsets have changed, and we have added new skills when hiring:  

  1. Digital mindset: involves more than having digital skills; it is a new way of thinking. It is about studying healthcare issues and searching for the right digital solution for the problems while avoiding high costs. The correct digital tools should be carefully designed and implemented to achieve the right benefits and profits, and we need people who care about what they are doing.  
  2. Understand and master change management: this is a relatively new discipline in management. Changes do not happen by themselves, and leaders need to manage change. In an environment that changes very quickly, we need leaders that understand and are proficient in change management.  
  3. Deliver an exceptional experience to the patient: it is not only about quality management but also about providing excellent service. We design our websites for those who use them to have a wonderful experience; the environment around our services must provide an unforgettable experience. Leaders must always participate in designing an exceptional experience for their customers and patients.  

EF: How do you balance having doctors from different generations in matters of digital progress?  

HG: By putting common objectives in the centre. We do not talk about generation differences but focus on common ground: our mission, the patients, and we always help those in need in the use of digital -help them get the right training- although we encourage people to educate themselves. A 65-year-old person that reports directly to me is going back to university to get another degree. I am always interested in new skills, not just classic cost management, revenue, or inventory; we need to go to the next level.  

EF: When you look back at this period in your professional career, how would you like to be remembered as a leader?  

HG: In bullfighting culture, when a bullfighter retires in glory –when the bulls don't retire him- they refer to him leaving by the "Puerta Grande" (a triumphant exit); that is how I would like to retire. I would like to retire by 2025, leaving a financially strong company behind me. A bigger, stronger, more efficient, and more human company. Bigger, as in more hospitals, more access, more patients, and more service lines. If we are stronger financially, our credit lines and better financial qualifications are better. More efficiency means we avoid waste, and finally, I am working at all levels of the company so that we are more compassionate and have more empathy. I hope that by 2025, I will retire, having achieved all the above. 

EF: How long have you worked in the company? 

HG: I am a surgeon, and I started as an independent practitioner. I started working in Christus Muguerza in June 2003 as a medical office in one of our facilities. This year is my 19th year as an employee and my 11th as the company's chief executive officer.  

EF: Is there any final message you would like to share? 

HG: Christus Muguerza never pays dividends; everything we make is reinvested in the organization for the benefit of society. We are a company intended for the community, a social purpose company.  

March 2022